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Outdated NHS targets to be overhauled in new pilot schemes

News, 11 March 2019

Four-hour wait time targets in A&E could be a thing of the past under new NHS plans aimed at improving care and saving more lives.

A raft of proposed clinical improvements have been published in an interim report that sets out initial proposals for testing changes to access standards in mental health services, cancer care, elective care and urgent and emergency care.

The aim is to lock in the benefits of existing targets – some of which date back more than 20 years – while updating them to ensure they support frontline staff to deliver on the NHS Long Term Plan’s ambitions to save hundreds of thousands more lives.

It is hoped a new measure of time in the emergency department will end hidden long waits and provide a more accurate view of hospital performance by recording how long every patient spends in A&E, not just whether their discharge or admission time breached the target.

This could prevent tens of thousands of unnecessary hospital admissions each year by improving upon the current four hour ‘cliff edge’ target.

Around a fifth of all emergency admissions from A&E happen in the final 10 minutes before the deadline, suggesting that hospitals are being driven to focus on the target, rather than what is the best approach for each patient.

In addition, the proposals will strengthen rules on reporting prolonged waits for those who need to be admitted to a ward, including reporting the most serious cases to the Care Quality Commission watchdog as a patient safety concern.

The four-hour A&E standard is just one area earmarked for reform. Other proposals include ensuring that patients experiencing a mental health crisis are able to access quick care in their own home or community, while no one who urgently needs help should wait more than 24 hours.

In addition, those who arrive at A&E experiencing a mental health crisis could receive emergency care within one hour. Detailed analysis is underway to build a full and accurate picture, but it is estimated that people go to their local A&E experiencing mental health problems up to a million times a year.

Other new standards to be trialled include faster life-saving treatment for those with the most critical conditions, such as heart attacks, sepsis, stroke and severe asthma attacks.

People with suspected cancer could also receive a definitive diagnosis within 28 days of urgent referral by their GP or a screening service as part of the proposals, which will be field tested by the NHS.

Reducing long waits for planned treatment such as cataract and hip operations will also be a priority, with a trial of an average measure for the start of treatment to tackle hidden waits, and reinforcing a six-week target for initial tests to take place.

Professor Stephen Powis, the NHS in England’s national medical director and leader of the review, said: “The NHS is aiming to improve care for patients and save hundreds of thousands more lives over the coming years, with greater access to mental health support, better treatment for the major killer conditions and services which are more joined-up, personalised and closer to home.

“So, as we build an NHS that is fit for the future, now is the right time to look again at the old targets which have such a big influence on how care is delivered, to make sure that they take account of the latest treatments and techniques, and support, not hinder, staff to deliver the kind of responsive, high-quality services that people want to see.”

Patient choice will also be reinforced, with hospitals expected to proactively support people who have waited for six months to find an alternative provider where they could be treated quicker, rather than the current system which places the onus on patients to ask for this to happen.

Staff bodies, patient groups and others will now be involved in the testing and development of the proposals, with evidence from the trials informing final recommendations.

These proposals will now be field tested at a selection of sites across England, before wider implementation.

The clinically-led review of standards was announced by the Prime Minister in June 2018, at the same time as she announced additional investment over the next five years to support the NHS’s plans for improved care, which were set out in the NHS Long Term Plan in January.

Since the Prime Minister made her request, Prof Powis has been working with leading national medical bodies, Healthwatch England, local hospital leaders and others on identifying and solving shortcomings in the current NHS target regime, which has developed over the last 20 years.

The review has focussed on determining what matters most to patients, on the clinical issues with the current target regime, and what NHS staff believe will help them provide the best quality care for patients.

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: “We know from many years of experience that, when implemented correctly, targets can be beneficial for the care patients receive from the NHS.

“To ensure that all targets are realistic and in the best interests of patient care at that time, it is sensible that they are regularly reviewed, and where appropriate, that alternatives are explored, tested and thoroughly evaluated to ensure that the care patients receive is always improving – to this end we support the course of action NHS England is taking, and we are pleased that the proposals will be piloted and evaluated before wider roll-out.”